Secondary Panoptix Toric Iol Implantation For Medical Rehabilitation In A Patient With Combined Ocular Pathology: A Case Of 40-Year Aphakia, Glaucoma, And High Myopia
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT097 | Type: Case Report | DOI: 10.82333/kkey-t060
Authors: Svetlana Don 1 , Galiya Yessenzhan 1 , Altynay Sadykova* 1
1Department of Ophthalmology,Kazakh Research Institute of Eye Diseases ,Almaty,Kazakhstan
Purpose
To evaluate the clinical feasibility and functional outcomes of secondary PanOptix Toric IOL implantation as a method of choice for comprehensive visual rehabilitation in a complex ocular setting. The study demonstrates the effectiveness of expanding standard protocols for premium IOL implantation in patients with long-standing post-traumatic changes, concomitant glaucoma, and extreme anisometropia, where traditional approaches often fail to restore binocularity.
Setting
The study was conducted at the Kazakh Eye Research Institute (Almaty, Kazakhstan). All surgical procedures and clinical examinations were performed by a single surgical team in an inpatient hospital setting during 2025.
Report of case
A 62-year-old male patient.
Medical history: In 1982, at the age of 19, the patient sustained a penetrating injury to the right eye (needle trauma). In the same year, extracapsular cataract extraction (ECCE) was performed due to traumatic cataract, resulting in aphakia. In 2024, primary open-angle glaucoma (POAG) was diagnosed in both eyes.
Clinical diagnosis:
OD — high myopia with astigmatism; corneoscleral scar; endothelial insufficiency; aphakia; secondary cataract; POAG stage II (medically controlled).
OU — anisometropia.
OS — low myopia; POAG stage I (medically controlled).
At presentation:
Uncorrected visual acuity (UCVA) OD was 0.05; best corrected visual acuity (BCVA) with sph (+)11.25, cyl (−)4.50 axis 130° was 0.2.
OS: BCVA 1.0 with sph (−)1.0.
Biometry: axial length (AL) OD 27.59 mm; OS 24.92 mm.
Surgical protocol: Considering the need to correct complex astigmatism and eliminate anisometropia to restore binocular vision, secondary implantation of a PanOptix Toric IOL (+11.5 D, T6) was performed in the capsular bag with simultaneous posterior capsulorhexis.
Results
Postoperative visual acuity in the right eye reached 0.9 for distance, 0.8 for intermediate, and 0.8 for near vision without additional correction.
The patient reported complete satisfaction with the visual outcome. Restoration of binocular comfort was achieved through compensation of anisometropia and astigmatism despite the presence of glaucomatous optic neuropathy and a 40-year history of aphakia.
Conclusion/Take home message
This clinical case expands the current understanding of the boundaries of trifocal optic application. Combined ocular pathology, including compensated glaucoma and post-traumatic changes, should not be considered an absolute contraindication to premium IOL implantation.
On the contrary, the use of toric multifocal lenses in cases of pronounced anisometropia represents a pathogenetically justified approach that enables maximal functional rehabilitation, even in cases previously regarded as unsuitable for advanced refractive correction.